Provider Demographics
NPI:1164657383
Name:SHAH, SHREYANSH (MD)
Entity Type:Individual
Prefix:
First Name:SHREYANSH
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WAC-7-721-J, 15 PARKMAN STREET
Mailing Address - Street 2:MASSACHUSETTS GENRAL HOSPITAL
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453
Mailing Address - Country:US
Mailing Address - Phone:281-827-5041
Mailing Address - Fax:
Practice Address - Street 1:WAC-7-721-J, 15 PARKMAN STREET
Practice Address - Street 2:MASSACHUSETTS GENRAL HOSPITAL
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453
Practice Address - Country:US
Practice Address - Phone:281-827-5041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP100349032084N0400X
DCMD0414332084N0400X
TXP57242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology